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All About Cholesterol - Part Two

Updated: Jan 21

Welcome to part two (of four) of all about cholesterol. If you have not read part one, we recommend you start there.

When we left off, we were discussing the questions you should be asking instead of just saying, “How do I lower my cholesterol?

Are there blood tests that can be helpful?

How do I know if I have plaque buildup in my arteries?

How can I prevent plaque from building up in my arteries?

What can I do if I have plaque buildup in my arteries?

Questions about the heart

Part two will go over these questions:

Are there blood tests that can be helpful?

How do I know if I have plaque buildup in my arteries?

Are there blood tests that can be helpful?

One of the first things to keep in mind when looking at cholesterol testing is that, in general, LDL and HDL levels do not tell you very much. You can have high LDL and be fine or have low levels and be at risk and vice versa.

Other tests can give you a much bigger picture of what is going on. Think of it as looking at the whole forest, not just a couple of trees.

You can talk to your doctor and see if any of these might be helpful in your particular case, and they may have others they think you should have as well. Having a thorough discussion with your doctor about your heart health is very important. The more information they have, the better they can help you.

Remember, when getting blood tests for lipids like cholesterol, it is essential to fast for nine to twelve hours before the test to ensure the most accurate results.

“Oxidized phospholipids are found on all apoB-containing lipoproteins, namely, LDL, VLDL, and especially Lp(a). When taken up by the artery wall, oxidized lipoproteins accelerate atherosclerosis, increasing the risk of myocardial infarctions, strokes, and calcific aortic valve stenosis. Oxidized phospholipids are highly pro-inflammatory and contribute to many diseases of aging.”

The second test is Lipoprotein(a) (Lp(a)). High levels of LPA can create plaque in your arteries and indicate coronary artery disease.

The third "test" (more of a calculation) is Very Low-Density Lipoprotein Cholesterol (VLDL-C).

“VLDL is a type of lipoprotein made in the liver that carries triglycerides and cholesterol. VLDL-C is the amount of cholesterol carried by VLDL lipoproteins.”

The best way to lower your VLDL is to reduce your triglycerides.

The fourth test is Triglycerides (TG).

“Elevated levels increase CVD risk by altering lipoprotein metabolism.”

“Enhance the formation of small dense LDL particles.”

“Contributes to low levels of large HDL particles.”

“This is a ratio calculated by dividing very-low-density lipoprotein cholesterol by triglycerides. A high ratio has been linked to abnormal lipid metabolism and increased risk of CVD events.”

The sixth "test" (more of a calculation) is the omega-six to omega-three ratio. Having a good balance of omega-six to omega-three is so helpful for keeping your arteries healthy. You can read more about it here.

The seventh test is a fibrinogen level test. High levels of fibrinogen can lead to increased plaque formation.

Last but not least is fasting insulin. This test measures the amount of insulin in your blood. Chronically high levels of insulin can lead to insulin resistance.

Insulin resistance is associated with a cluster of cardiometabolic risk factors known collectively as the insulin resistance (metabolic) syndrome (IRS). Knowing your Triglyceride/HDL ratio can help you understand your risk of insulin of resistance.


Regular check-ups and bloodwork are essential, don't put them off any longer.

How do I know if I have plaque buildup in my arteries?

Your doctor can run some tests to determine plaque buildup in the arteries.

You can talk to your doctor and see if these might be helpful in your particular case, or they may refer you to a cardiologist if you need more specialized care.

“A calcium-score screening heart test (coronary calcium scan) uses computerized tomography (CT) to detect calcium deposits in the coronary arteries of your heart. A higher coronary calcium-score suggests you have a higher chance of significant narrowing in the coronary arteries and a higher risk of a future heart attack.”

If you have a stent, this test will not provide as much information, as the stent can interfere with the test results. In addition, a calcium score does not mean there is no plaque at all, as it will not exclude the presence of soft non-calcified plaque. However, this test provides valuable information and is incredibly useful.

"The carotid intima-media thickness test (CIMT) is a measure used to diagnose the extent of carotid atherosclerotic vascular disease. The test measures the thickness of the inner two layers of the carotid artery—the intima and media—and alerts physicians to any thickening when patients are still asymptomatic.”

This test is not widely available and may be hard to get.

“A stress test also called an exercise stress test, shows how your heart works during physical activity. Because exercise makes your heart pump harder and faster, an exercise stress test can reveal problems with blood flow within your heart.”

It's time to head to part three as we delve deeper.

professor dog

Professor Dog says to get a snack and move on to part three.


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